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Fight note bloat in Epic

Epic. It's bringing you a lot of cool things, but change is always a little scary. So, the MSA is going to help with tips designed just for your practice. You can always find these on the MSA blog. Doctors working to help build HHS’ Epic system will be writing these blogs. Some will help you to manage the change, some will help you understand the difference between what you do now and what you will be able to do in Epic, and some will be about Epic’s cool tools for physicians.

You’re no doubt thrilled that with Epic, you’ll no longer have to hunt for bulky binders on the ward, or worry that your dictations will be lost in the ether. That said, Epic brings new challenges and opportunities to improve physician documentation.

One such challenge and opportunity is note bloat . Epic makes it almost too easy to ‘pull in’ data from the medical record, which can result in a muddled, hard-to-read mess that makes providing good care harder.

The patient record in Epic is a ‘single source of truth’ that we are all responsible for maintaining. Keeping the patient history and problem list up-to-date will save you time later—it takes the place of pulling in data and only needs to be done once – we can learn from the CPP that our family practitioners keep.

So, more documentation is not better documentation. The goal should be to maintain quality documentation. Here are four simple tips to help you do that:

1. Epic automatically tracks what you have reviewed (and when), so you don’t need to worry about regurgitating every bit of information you see in the patient record.

2. Document what’s important to your decision-making: pertinent positives and negatives.

Quality documentation is personalized documentation – ‘here’s what I saw, here’s what I thought, here’s what we did and why’. You’re not a scribe, you’re a physician; we care about what you think and do, not what you copied off the computer screen.

As per the CPSO: “A good note should allow a subsequent reader to place themselves in your shoes and understand your diagnostic reasoning, your justification for excluding other diagnoses, and your reasons for proceeding as you did. Clinical notes do not need to be exhaustive, but should give an adequate picture of the clinical situation.”

3. Get rid of the SOAP – switch to the APSO format.

APSO — Assessment, Plan, Subjective, Objective— flips the traditional clinical note on its head, and for good reason. When people read your note, they are most interested in your assessment and plan. APSO puts these at the TOP of the note, so that when you’re reviewing that cardiology consult, you can see what they suggest, and why. (Let’s be honest… we all skip to the end of the consult note first!) This also counters note bloat, by putting the worst offenders (subjective and objective) at the end of the note where they will cause the least harm.

4. Stick to Epic’s documentation templates.

The Project Odyssey team has worked hard to create core note templates for use across HHS. We looked at notes from other Epic organizations across Canada, cross-referenced them with policies from the CMPA and CPSO, and had the OMA Tariffs Committee review the templates to ensure they met all the requirements for billing. While each specialty and each clinician will want to personalize their notes, we encourage you to stick closely to the core templates to ensure your notes are clean, lean, and mean.

We want folks to look at HHS and say: “Wow, HHS notes are great. I can find the assessment and plan without having to sort through 10 pages of useless, pre-populated note bloat.”

Fighting note bloat protects patients, protects you, and will make your Epic experience even better.

Medical Staff Association Executives would like to thank Dr. Simon Oczkowski for contributing to today's blog post! Dr. Simon Oczkowski is an associate chief medical information officer for Project Odyssey and one of the physicians helping to lead the way to Epic go-live in June 2022. More information about Project Odyssey is available on the HHS Hub . (Must be in Citrix.)

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